My Community Fund form

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蘑菇视频, in partnership with some of our Suppliers, offers grants to community organisations across our geography who are actively working for the benefit of our customers.

This application form has been designed to assess whether your request is linked to our business objectives and community priorities. Please answer with as much detail as possible, attach additional sheets if necessary.

Application details

Name of the group or organisation applying(Required)

Name of your project and project address(es)(Required)

Name of the person applying

First Last Position (if relevant)

Contact phone number for person applying(Required)

Contact address for person applying(Required)

Street Address Address Line 2 City Post code

Contact email for person applying(Required)

In financial terms what level of sponsorship do you require?(Required)

Please tell us about your project and how the funding will be used(Required)

Please give a breakdown of total project costs and attach a copy of any quotes (over 拢200)(Required)

Item

Amount

Total(Required)

Please attach a copy of any quotes over 拢200

Drop files here or

Max. file size: 50 MB.

If the total of your project is more than you have asked for tell us where the rest of the funding will come from:

Sponsor/donation/fundraising/grants

Amount applied for

Amount secured

Eg: Actual amounts from Sponsors, donations, fundraising

Total

Qualification questions

Can all members of the public access the event, item or project or is it targeted at a particular community?(Required)

We give priority to projects that benefit the communities in which we work. Will the event, item or project benefit people who live in the following areas?(Required)

Please tick all that apply

Please specify which area e.g. Codsall, Cannock, Shifnal, Stafford, Wellington(Required)

Will the event, item or project benefit customers of 蘑菇视频, the people who live in our homes and communities?(Required)

Yes

Please explain how(Required)

Will the event, item or project promote sustainability and environmental issues?(Required)

Yes

Please explain how(Required)

Explain why you are passionate about this event, item or project and why 蘑菇视频 should offer funding(Required)

Does your group/organisation have an equal opportunities policy?(Required)

Yes

If no, are you willing to agree to comply with the following statement:?

鈥淥ur organisation does not discriminate on the grounds of race, ethnic origin, nationality, religion, cultural background, sex, sexual orientation, domestic circumstances, disability or age.鈥�

Yes

Are you employed by, closely related to, or in a relationship with an employee, member of the community panel or Board member of 蘑菇视频?(Required)

Yes

If yes, please give details

Safeguarding – Does your project involve working with children, young people (under the age of 18) or vulnerable adults?(Required)

Yes

If yes, you may be asked to provide a copy of your Safeguarding Policy and Procedures.

Do all the project worker(s) have an up to date Disclosure Barring Service check?

Yes

Health and Safety 鈥� Are there any significant health and safety implications relating to this project?(Required)

Yes

Have you undertaken a Risk Assessment?

Yes

Copies may be requested.

Terms and Conditions

Each application will be evaluated on the information presented in this form.
The information given will be rated against an agreed scale of suitability and value for money.
The decision of the Community Fund panel is final.
蘑菇视频 will aim to respond to the applicant within four to six weeks from the date of application, unless further investigation or information is required.
Due to the demand for community funding 蘑菇视频 applications may be limited to one request per organisation per year.
蘑菇视频 reserves the right to refuse funding to an organisation or event that is profit-making or has restricted membership.
蘑菇视频 promotes and seeks to achieve equality of treatment for everyone without discrimination or prejudice on the grounds of race, ethnic origin, nationality, religion, cultural background, sex, sexual orientation, domestic circumstances, disability, or age. The Group reserves the right to refuse funding to an organisation or event that does not promote equality and diversity.
If funding is awarded, the applicant agrees to take part in any reasonable publicity organised by 蘑菇视频 or one of its partner organisations, this may include photography. (See below re consent)

Please tick this box to confirm that you accept the terms and conditions(Required)

Tick

Data Protection Statement

蘑菇视频 requires the information requested on this form in order to assess whether to grant funding. Members of the Decision Panel will receive copies of all information submitted as part of this application in order to make this assessment.

All personal information will be processed in accordance with our

Funding will be conditional on you providing feedback on the project such as a brief written report and photographs. We expect you to have obtained the necessary consents to use the photographs in line with the Data Protection Act 2018 (which includes General Data Protection Regulations).

With your consent, 蘑菇视频 will publicise the award, both internally and externally, including but not limited to social media (Facebook, Twitter), media publications (newspapers, magazines), websites and displayed at events (eg County Shows, Open Days etc.).

You have the right to withdraw your consent to photographs at any time by phoning us on 0800 007 4567, by writing to us at 蘑菇视频, Acton Court, Acton Gate, Stafford, ST18 9AP

By signing this form, you agree to all the above.

Signed (print name)(Required)

On behalf of (organisation)(Required)

Date(Required)

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蘑菇视频

Application details

Qualification questions

Terms and Conditions

Data Protection Statement

Existing customers

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